Claim total
$641.13
base $93.83 · payer covered $541.13
The visit
- Class
- Wellness
- Code
- 410620009
- Reason
- —
- Start
- 2022-04-05
- Stop
- 2022-04-05
The parties
- Patient
- patient An Wenona Rau
- Provider
- provider Lowell Blick
- Payer
- payer Medicaid
Record id
04682680-f77d-0a00-4211-07b952732617